Usability of an Automated System for Real-Time Monitoring of Shared Decision-Making for Surgery: Mixed Methods Evaluation.

BACKGROUND: Improving shared decision-making (SDM) for patients has become a health policy priority in many countries. Achieving high-quality SDM is particularly important for approximately 313 million surgical treatment decisions patients make globally every year. Large-scale monitoring of surgical patients' experience of SDM in real time is needed to identify the failings of SDM before surgery is performed. We developed a novel approach to automating real-time data collection using an electronic measurement system to address this. Examining usability will facilitate its optimization and wider implementation to inform interventions aimed at improving SDM. OBJECTIVE: This study examined the usability of an electronic real-time measurement system to monitor surgical patients' experience of SDM. We aimed to evaluate the metrics and indicators relevant to system effectiveness, system efficiency, and user satisfaction. METHODS: We performed a mixed methods usability evaluation using multiple participant cohorts. The measurement system was implemented in a large UK hospital to measure patients' experience of SDM electronically before surgery using 2 validated measures (CollaboRATE and SDM-Q-9). Quantitative data (collected between April 1 and December 31, 2021) provided measurement system metrics to assess system effectiveness and efficiency. We included adult patients booked for urgent and elective surgery across 7 specialties and excluded patients without the capacity to consent for medical procedures, those without access to an internet-enabled device, and those undergoing emergency or endoscopic procedures. Additional groups of service users (group 1: public members who had not engaged with the system; group 2: a subset of patients who completed the measurement system) completed user-testing sessions and semistructured interviews to assess system effectiveness and user satisfaction. We conducted quantitative data analysis using descriptive statistics and calculated the task completion rate and survey response rate (system effectiveness) as well as the task completion time, task efficiency, and relative efficiency (system efficiency). Qualitative thematic analysis identified indicators of and barriers to good usability (user satisfaction). RESULTS: A total of 2254 completed surveys were returned to the measurement system. A total of 25 service users (group 1: n=9; group 2: n=16) participated in user-testing sessions and interviews. The task completion rate was high (169/171, 98.8%) and the survey response rate was good (2254/5794, 38.9%). The median task completion time was 3 (IQR 2-13) minutes, suggesting good system efficiency and effectiveness. The qualitative findings emphasized good user satisfaction. The identified themes suggested that the measurement system is acceptable, easy to use, and easy to access. Service users identified potential barriers and solutions to acceptability and ease of access. CONCLUSIONS: A mixed methods evaluation of an electronic measurement system for automated, real-time monitoring of patients' experience of SDM showed that usability among patients was high. Future pilot work will optimize the system for wider implementation to ultimately inform intervention development to improve SDM. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2023-079155.

Comparative evaluation of open book and conventional assessment methods in medical undergraduate students.

Medical science is a dynamic field of knowledge that is constantly broadening with upcoming clinical research and analysis. Traditional medical education has been focused on textbook-based recall assessments-closed book assessment (CBA). However, the availability of newer technologies has made the accessibility to encyclopedic knowledge expeditious, which demands for a new approach for medical education. As medical professionals, the purpose of learning should be higher cognitive skills such as interpretation and synthesis. So, analyzing students' ability to comprehend the concepts and learning to apply it in a realistic context than merely recalling the facts has come into attention. In this study, we aimed to evaluate and compare the performance of 250 first-year MBBS students at Maulana Azad Medical College, New Delhi, India, between closed book and open book method for biochemistry. Students were divided into two groups, Group A and Group B, based on their average monthly internal assessment marks. CBA was followed by open book assessment (OBA) 1 week apart with similar questionnaire pattern and allotted time. A significant difference in average marks obtained by the two groups was observed in CBA. Group A scored better in CBA, but performance was comparable with Group B in OBA. OBA and CBA can contribute to an assessment program in part because of their complementary pros and cons, and OBA should not be thought of as an alternative to CBA, but their value may be in expanding beyond what is measured by CBA.

"Nobody has written the book about what non-binary people should put forward in relationships": Exploring gender equity in relationships of queer, trans, and non-monogamous young women and non-binary youth in British Columbia, Canada.

Understanding the unique ways in which queer, trans, and non-monogamous young women and non-binary youth navigate and negotiate equitable intimate relationships is a first step toward strong research, programs/resources, and policies to support healthy relationship dynamics across the life course. Using a youth-engaged collaborative Reflexive Thematic Analysis, we aimed to explore how youth of diverse genders and relationship experiences understand gender equity in their relationships. Thirty cis- and transgender inclusive young women (46.7%) and non-binary youth (53.3%) aged 17-29 who were in a current (76.6%) or recent (in past 12 months, 23.4%) non-heterosexual and/or non-monogamous intimate relationship and residing in British Columbia, Canada, completed qualitative interviews between August and November 2022. Of the 30 youth, 53.3% reported having experience living as a trans person, 33.3% identified only as bisexual and 10% identified as only lesbian or gay, whereas the remaining 56.7% identified with ≥1 of: queer, pansexual, and demisexual. Participants identified that relationship equity requires: 1) Moving away from cis-heteronormative conceptualizations of gender roles and norms; 2) Actively working to dismantle hierarchal power structures by sharing power, responsibility, labour, and decision-making; and 3) Accommodating and affirming each person's unique needs and identities in a relationship. For theme one, youth further described the ways in which they re-imagined relationship norms and discussed the various challenges to resisting ingrained hierarchical cis-heteronormativity. This research contributes a greater understanding of how to create equitable and healthy relationships and has important implications for healthcare providers, educators, and policymakers working with queer, transgender, and non-monogamous youth.

Digital thErapy For Improved tiNnitus carE Study (DEFINE): Protocol for a randomised controlled trial.

Tinnitus is a common health condition, affecting approximately 15% of the UK population. The tinnitus treatment with the strongest evidence base is Cognitive Behavioural Therapy (CBT), with standard tinnitus therapy typically augmented with education, relaxation and other techniques. Availability of CBT and conventional tinnitus therapy more broadly is limited for tinnitus sufferers. The DEFINE trial aims to assess whether smartphone-delivered tinnitus therapy, the Oto app, is as effective as current standard care, one-to-one therapist-delivered tinnitus treatment for the treatment of tinnitus in adults. The trial is registered in the ISRCTN Registry: ISRCTN99577932. DEFINE is an open-label, non-inferiority, prospective, parallel design, randomised-controlled trial. Recruitment, interventions and assessments will be remote, enabling UK-wide participant involvement. 198 participants aged 18 years or more will be recruited via social media advertisement or via primary care physicians. A screening process will identify those with tinnitus that impacts health-related quality of life, and following consent smartphone-based audiometry will be performed. Randomisation 1:1 to the Oto app or one-to-one therapist-led tinnitus therapy will be performed centrally by computer, matching groups for age, sex and hearing level. Following participant allocation, the Oto app will be provided for immediate use, or a one-to-one remote therapy appointment booked to occur within approximately 1 week, with up to 6 sessions delivered. Participant outcomes will be collected at 4,12, 26 and 52 weeks via questionnaire and phone call. The primary outcome is the change in Tinnitus Functional Index (TFI) total score measured at 26 weeks following allocation. Adverse events will be recorded. A health economic evaluation in the form of a cost-utility analysis will be performed using data from participant submitted EuroQol 5D-5L and Health Utilities Index Mark 3 scores and resource use data. Trial results will be made publicly available, including a plain English summary.

Assessment of volatile emissions by aging books.

Indoor air quality (IAQ) has attracted a lot of attention due to its complexity and direct effect on human health. Indoor settings in libraries entail various volatile organic compounds (VOCs) linked to the aging and degradation of print material. The effect of the storage environment on paper life expectancy was investigated by targeting the VOC emissions of old and new books using headspace solid phase micro extraction-gas chromatography/mass spectrometry (HS-SPME-GC/MS) analysis. "Sniffing" of book degradation markers showed both ubiquitously and infrequently occurring VOCs. Old book "degradomics" revealed mostly alcohols (57%) and ethers (12%), whereas new books resulted mainly to ketones (40%) and aldehydes (21%). Chemometric processing of the results with principal component analysis (PCA) corroborated our initial observations and was able to discriminate the books by age into three groups: very old books (from the 1600 s to mid-1700), old books (from the 1800s to the early 1900s), and modern books (from the mid-twentieth century onwards) based on their gaseous markers. The measured mean concentrations of selected VOCs (acetic acid, furfural, benzene, and toluene) were below the respective guidelines set for similar places (i.e. museums). The applied non-invasive, green analytical methodology (HS-SPME-GC/MS) can assist librarians, stakeholders, and researchers to evaluate the IAQ, as well as the degree of degradation, and take the appropriate measures for book restoration and monitoring protocols.

Genomics-informed nursing strategies and health equity: A scoping review protocol.

OBJECTIVE: The objective of this scoping review is to map the available evidence on strategies that nurses can use to facilitate genomics-informed healthcare to address health disparities. INTRODUCTION: Advancements in genomics over the last two decades have led to an increase in the delivery of genomics-informed health care. Although the integration of genomics into health care services continues to enhance patient outcomes, access to genomic technologies is not equitable, exacerbating existing health disparities amongst certain populations. As the largest portion of the health workforce, nurses play a critical role in the delivery of equitable genomics-informed care. However, little is known about how nurses can help address health disparities within the context of genomics-informed health care. A review of the literature will provide the necessary foundation to identify promising practices, policy, and knowledge gaps for further areas of inquiry. INCLUSION CRITERIA: We will include papers that explore strategies that nurses can undertake to facilitate genomics-informed care to address health disparities. METHODS: This review will be conducted using JBI methodology for scoping reviews. We will search electronic databases including MEDLINE (OVID), EMBASE, Cochrane Library, PsychInfo, and CINAHL for quantitative and qualitative studies, systematic reviews and grey literature. Theses, books, and unavailable full-text papers will be excluded. The search will be limited to papers from 2013 and beyond. Two reviewers will screen titles and abstracts followed by full-text and disagreements will be resolved by a third reviewer. We will use a data extraction tool using Microsoft Excel and analyse data using descriptive statistics and conventional content analysis. Findings will be presented in the form of evidence tables and a narrative summary. We will report findings using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). DISCUSSION: Genomics will continue to transform all aspects of health care across the wellness continuum from prevention, assessment, diagnosis, management, treatment, and palliative care. The identification of nursing strategies to address health disparities will build the foundation for policy and practice to ensure that the integration of genomic technologies benefits everyone.

NIH funding for patents that contribute to market exclusivity of drugs approved 2010-2019 and the public interest protections of Bayh-Dole.

Previous studies have shown that National Institutes of Health (NIH) funding contributed >$187 billion for basic or applied research related to the 356 drugs approved 2010-2019. This analysis asks how much of this funding led to patents cited as providing market exclusivity, patents that would be subject to the provisions of the Bayh-Dole Act that promote and protect the public interest. The method involves identifying published research in PubMed related to the approved drugs (applied research) or their targets (basic research). NIH-funded projects (grants) funding these publications and patents arising from these projects were both identified in RePORT. Patents cited as providing market exclusivity were identified in DrugPatentWatch (which incorporates FDA Orange Book). NIH funded basic or applied research related to all 313 FDA-approved drugs 2010-2019 with at least one patent in DrugPatentWatch. This research comprised 350 thousand publications (9% applied research; 91% basic research) supported by 341 thousand fiscal years (project years) of NIH funding and $164 billion in NIH project year costs (17% applied research; 83% basic research). These NIH projects also produced 22,360 patents, 119 of which were cited in DrugPatentWatch as protecting 34/313 drugs. These patents were associated with 769 project years of NIH funding (0.23% total) and project year costs of $0.95 billion (0.59% total). Overall, only 1.5% of total NIH funding for applied research and 0.38% of total NIH funding for basic research was associated with patents in DrugPatentWatch. This analysis shows that very little of the NIH funding for research that contributes to new drug approvals leads to patents that provide market exclusivity and are subject to the provisions of the Bayh-Dole Act that promote the public interest in practical applications of the research, reasonable use and pricing, and a return on this public sector investment. This suggests that the Bayh-Dole Act is limited in its ability to protect the public interest in the pharmaceutical innovations driven by NIH-funded research.

A Qualitative Assessment of Community Acceptability and Use of a Locally Developed Children's Book to Increase Shared Reading and Parent-Child Interactions in Rural Zambia.

Introduction: Early reading interventions hold promise for increasing language and literacy development in young children and improving caregiver-child interactions. To engage rural caregivers and young children in home reading, Zambian child psychologists and education specialists developed a culturally representative, local language children's book targeted at pre-grade 1 children. Objectives: We qualitatively assessed community acceptability and use of the book distributed to households with young children in two provinces of Zambia. Methods: We conducted 15 focus group discussions (FGDs) with women (n=117) who received the "Zambian folktales adapted stories for young children" book. A codebook was created a priori, based on established themes in the guide; content analysis was conducted in Nvivo v12. Data were interpreted against the Theoretical Framework on Acceptability. Findings: Respondents described wide acceptability of the children's book across multiple framework constructs. Respondents believed the book was culturally appropriate for its folktale structure and appreciated the morals and lessons provided by the stories. Respondents described using the book in multiple ways including reading in one-on-one or group settings, asking the child questions about the narrative or pictures, and providing additional commentary on the actions or figures in the pictures. Respondents believed the books were helping children grow their vocabulary and early literacy skills. The book's simple vocabulary facilitated use by less educated caregivers. The primary concern voiced was the ability of low literacy caregivers to utilize the book for reading. Discussion: The children's book was widely considered acceptable by rural Zambian communities. It provided a platform for an additional method of caregiver-child interactions in these households for reading, dialogue, and oral storytelling. Shared reading experiences have potentially substantial benefits for the language development and emergent literacy of young children. Programs to develop and deliver culturally acceptable books to households with limited access should be considered by governments and funders.

Realistic Assessment of Research Publications by Neurosurgery Residency Applicants.

OBJECTIVE: Neurosurgical residency applicants' prior research experience can amplify their ability to stand out to prospective neurosurgery programs. We attempted to accurately quantify the number of research publications coauthored by applicants by analyzing the publications of applicants who matched into neurosurgery in the 2021 Match. METHODS: Scopus, a peer-reviewed literature database, was queried for publications by applicants who matched into neurosurgery in the 2021 Match before the finalization of rank lists. Conference papers, abstracts, and book chapters were excluded to determine an accurate average of actual publications. Descriptive statistics for resident publication data were used, with a Mann-Whitney U test used to compare research productivity between male and female residents. RESULTS: There were 234 positions filled by the 2021 Match, and 233 neurosurgical residents were identifiable in this study. A total of 187 residents matching from U.S. Doctor of Medicine and Doctor of Osteopathic Medicine programs were identified with 946 total publications-an average of 5.1 publications per resident. Analysis of descriptive statistics revealed type of research conducted, authorship information, most published journals, and citation data. Significant differences were found in the number of publications between male and female applicants with averages of 5.6 and 3.8 publications, respectively. CONCLUSIONS: Students matriculating to neurosurgery residency programs display a wide range of research productivity. Typical U.S. Doctor of Medicine and Doctor of Osteopathic Medicine applicants have coauthored a mean of 5.1 and a median of 4.0 publications. This information may assist program directors in weighing applicants' research background and give medical students interested in the field reasonable research expectations.

Legal advice and care-effective use of care and case management: limits, risks and need for change (funded by the innovation Fund of the Federal Joint Committee (G-BA) according to §§ 92a and 92b of the fifth book of the German social code (SGB V). Funding code 01NVF17029 (RubiN) regional uninterrupted in the network).

INTRODUCTION: An important dimension of care and case managers is to support geriatric patients in obtaining social services in medical, nursing, therapeutic and social fields. To this, they advise and represent their patients. METHODS: The documentation of patient contacts with case managers of a network of physicians was evaluated. In particular, activities involving legal advice were analysed in detail, compared with the current legal situation in Germany and evaluated. In addition, qualitative expert interviews were conducted. The content and the legal requirements of legal services law were determined by applying legal interpretation methods (esp. wording, telos, systematics). The results of the evaluation of the documentation were compared with legal requirements. RESULTS: Care and case management touches activities in some fields of action without having a legal basis in legal services law. This leads to the fact that these services may not be provided and to - uninsured and uninsurable - liability risks. DISCUSSION: With the introduction of care and case management into standard care, both social law and the Legal Services Act must be adapted to enable the legally compliant use of care and case managers. Otherwise, certain services that are useful for the care of patients may not be provided.

Financial concern reduces child directed speech in a socioeconomically diverse sample.

Socioeconomic status predicts the quantity and nature of child-directed speech that parents produce. However, the mechanisms underlying this relationship remain unclear. This study investigated whether the cognitive load imposed by resource scarcity suppresses parent talk by examining time-dependent variation in child-directed speech in a socioeconomically diverse sample. We predicted that child-directed speech would be lowest at the end of the month when Americans report the greatest financial strain. 166 parents and their 2.5 to 3-year-old children (80 female) participated in a picture-book activity; the number of utterances, word tokens, and word types used by parents were calculated. All three parent language measures were negatively correlated with the date of the month the activity took place, and this relationship did not vary with parental education. These findings suggest that above and beyond individual properties of parents, contextual factors such as financial concerns exert influence on how parents interact with their children.

Fixing The FDA's Orange Book.

The modern regime for balancing innovation and competition in pharmaceuticals was established through the Drug Price Competition and Patent Term Restoration Act of 1984, also known as the Hatch-Waxman Act. This regime needs updating. The process that Hatch-Waxman established for listing patents and challenging patents on the Food and Drug Administration's Orange Book is one important area for reform.

Sanctions for Intimate Partner Sexual Violence: Is the Law on the Books the Law in Action?

Intimate partner sexual violence (IPSV) is common, yet in many jurisdictions the law still does not adequately recognize it. In those jurisdictions that have formally criminalized IPSV, little is known about the extent to which IPSV-related law on the books is implemented in practice. Especially scarce is systematic quantitative evidence on the processing of IPSV cases by the justice system. We investigate unique case-level court data on the processing and sanctioning of violent sex crime cases in Belgium, a jurisdiction where the law adequately criminalizes IPSV, but where criminal judges are afforded broad sentencing discretion. Our data allow us to observe both the conviction and the sentencing decision. Consequently, we are able to address the endogenous sample selection concerns that arise in the assessment of IPSV-related sentencing disparities by estimating a full-fledged sample selection model. Upon inclusion of a broad range of defendant, victim, and other case controls, we show that defendants who are the victims' spouses or partners receive statistically significantly shorter prison sentences than defendants who are unrelated to the victims, in the sense that they are neither the victims' current or former spouses nor family. The documented extralegal disparity is quantitatively noteworthy and survives a series of robustness checks as well as alternative model specifications. Our analysis thus lends empirical credibility to the perspective that while national legislatures have often been slow to address IPSV, the justice systems may be even slower at internalizing the corresponding law. Our evidence-based insight into de facto legal responses to IPSV is of direct relevance to many jurisdictions globally.

Book Review: Wittenberg, E., Goldsmith, J. V., Ragan, S. L., & Parnell, T. A. (2020). Caring for the Family Caregiver: Palliative Care Communication and Health Literacy. Oxford University Press.

Caring for the Family Caregiver is published by Oxford University Press and introduces the novel framework of the Family Caregiver Communication Typology. The volume offers a close analysis of caregiver health literacy and patient outcomes and invites readers to consider the family system as the driver in shaping how family caregivers deal with chronic illness demands. The expertise of all authors (three health communication scholars and one nurse who is a health literacy expert) in the analysis illuminates the delicate balance between caregivers' ability to understand and communicate in the context of social determinants of health. The book shares the interwoven challenges of palliative care, family caregiving, and health literacy. Caring for the Family Caregiver establishes the urgent call to address family caregiver information and communication needs and leaves the reader empowered to make changes in their own clinical practice communication and/or develop family caregiving research that addresses cultural and social factors.

Beyond property or beyond Piketty?

Capital and Ideology represents a significant further statement from Thomas Piketty. The arguments made by the "New Piketty" are largely compatible with those of his previous Capital in the Twenty-First Century, but reflect broadening of scope and deepening of causal analysis, most markedly through the adoption of a world historical perspective. The result is a fuller offering for understanding inequality's pattern in the world, why it exists and how we can best respond to it. The book presents a wide range of arguments, which do not on first glance appear unified. This review essay distills these into six propositions, describes and evaluates each in turn, and identifies some threads that link them. In the process, it provides a critical assessment of Capital and Ideology.

Validation of The Reading House and Association With Cortical Thickness.

BACKGROUND AND OBJECTIVES: The American Academy of Pediatrics recommends literacy and school readiness promotion during well visits. The Reading House (TRH) is a children's book-based screener of emergent literacy skills in preschool-aged children. Vocabulary, rhyming, and rapid naming are core emergent skills, and reading abilities are associated with thicker cortex in the left hemisphere. Our objective was to expand validity of TRH relative to these skills and explore association with cortical thickness. METHODS: Healthy preschool-aged children completed MRI including a T1-weighted anatomic scan. Before MRI, TRH and assessments of rapid naming (Comprehensive Test of Phonological Processing, Second Edition), rhyming (Pre-Reading Inventory of Phonological Awareness), vocabulary (Expressive Vocabulary Test, Second Edition), and emergent literacy (Get Ready to Read!) were administered. Analyses included Spearman-ρ correlations (r ρ) accounting for age, sex, and socioeconomic status (SES). MRI analyses involved whole-brain measures of cortical thickness relative to TRH scores, accounting for covariates. RESULTS: Seventy children completed assessments (36-63 months old; 36 female) and 52 completed MRI (37-63 months; 29 female). TRH scores were positively correlated with Comprehensive Test of Phonological Processing, Second Edition (r ρ = 0.61), Expressive Vocabulary Test, Second Edition (r ρ = 0.54), Get Ready to Read! (r ρ = 0.87), and Pre-Reading Inventory of Phonological Awareness scores (r ρ = 0.64; all P < .001). These correlations remained statistically significant across age, sex, and SES groups. TRH scores were correlated with greater thickness in left-sided language and visual cortex (P-family-wise error <.05), which were similar for higher SES yet more bilateral and frontal for low SES, reflecting a less mature pattern (P-family-wise error <.10). CONCLUSIONS: These findings expand validation evidence for TRH as a screening tool for preschool-aged children, including associations with emergent skills and cortical thickness, and suggest important differences related to SES.